A first occurred on my last EMS shift. Thankfully it wasn’t as bad as the first I described in a previous post. This first, while kind of annoying was interesting and, I’m sure, a true rarity in EMS.

My partner and I got woken up in the middle of the night for someone who was bleeding. Right as I had gotten dressed and was about to zip up my boots, the phone rang again and we were told to cancel. So, I get back in the bed and about 10 minutes later the phone rings again and we were told to roll after all. So, we roll and as soon as we get out of the truck we’re met at the door by a very large man and I could tell that he was somewhat unhappy. He tells us, “I told my son not to call you guys, I don’t need an ambulance. Where do I sign so we can all go back to bed?”

WHAT?!

I was in disbelief. Not that we got called to a house and the patient refused (this had actually been happening on my truck all day) but rather that we went to a house in the middle of the night and got a refusal. This does not happen! I’ve gone to houses for itching, a hangnail and even trouble sleeping and wound up hauling those patients. This person bled and still refused?

Shock and awe!

And in case you’re wondering, they really didn’t need us or to go to the hospital. It was a scratch but the son was worried because it kept bleeding (however there was not much blood involved – more of annoyance on the patient’s part).

Just thought I’d share that little tidbit. Again, I don’t hear much of getting a refusal when called out in the middle of the night and this was the first time it had ever happened to me.

I also need to vent a little. Well, maybe “vent” isn’t the right term because I’m not mad about this situation. I am disappointed but I honestly can’t say I’m mad about it. Anyway… I was hoping to go to paramedic school this fall but it doesn’t look like I’ll be going (unless something changes by the end of this week). The problem I ran into was my works schedule. Unfortunately, arrangements couldn’t be made that would allow both days in my normal shift to be covered and that would allow me to work weekends while I’m in school. As I said, it’s OK. I’ll have more time to get more experience and to take a couple of classes I needed before I started medic school. All of this should lead up to me being more prepared when I enroll next year.

However, this situation did give some food for thought.

When someone is hired by a fire or police department, they, of course, have to obtain their respective certifications. The department pays their tuition and other school related fees, they provide them a vehicle or otherwise pay for their transportation to and from the academy and they pay their salary while they’re completing their training. If any additional classes are required (such as EMT-Basic in the case of many fire departments), they pay their expenses and accommodate their schedule. The thought I pondered is why isn’t EMS the same way? Sure, we are different from the fire and police departments but ultimately we are also an emergency service. I’m not saying that EMS agencies should pay for someone to take their Basic class but it sure would be nice for most places to at least help someone wanting to obtain paramedic licensure. Not only that, they should be more apt to accommodating schedules. I realize that EMS is a 24/7 operation and must be fully staffed at all times. However, the fire and police departments can pull it off so why not EMS?

The consensus in an informal poll I did on Twitter seems to be that many agencies leave it up to the employee to arrange shift trades or to take personal time off (and still arrange for someone else to cover the shift) in order to take their classes. While I understand this, I could also see the want and need for EMS to be more like the fire and police folks, in that they’re more likely to encourage a Basic to obtain further training by accommodating at least one or two students’ schedules per year..

However, keep in mind that I’m a little biased in this right now and I’m looking at this mostly from my point of view.

In other news, next week is National EMS Week. I’ll make another post about that (hopefully) over the weekend. Think of ways that you’d not only like to be thanked for all the sacrifices you make for others but also how you can recognize peers who go above and beyond. Also, look for opportunities to educate the public about just what it is that we do. I want to take this opportunity to thank all of the EMS people, including my dad, who have had and continue to have a hand in my development as an EMT. I appreciate you all more than you know. I also appreciate those who got the EMS 2.0 movement going. Even though I’m still learning, I know that EMS needs to be overhauled and I’m thankful to be able to say that, in some small way, I’m a part of all this thunder that’s being made in all corners of the U.S.

After spending most of yesterday in recovery from a near-sleepless night at the EMS, I logged on to Twitter today and noticed an interesting tweet from Chris Kaiser (@ckemtp on Twitter – an all around good fellow and follow, by the way). It was a link to an article about apathy in EMS. The article, entitled “Apathy in EMS is Pathetic” asks some hard questions that all of us in EMS should be asking ourselves: “Do EMS providers really care about EMS, or is it just a temporary job until something better comes along? Is it just a young person’s game? Do EMS providers really care about the profession as a whole and worry about its future?” Often I wonder the same things that Dr. Bledsoe asks in his article. Why do so many EMS people seem to apathetic when it comes to their field?

When it comes to people in my area, I can’t help but think that a lot of them don’t speak up more for positive changes because “it’s just the way it is and the way it always has been.” Evidently they’re not alone. A survey conducted by JEMS indicates that, despite safety concerns, the average EMS shift in the cities surveyed in their 200 City Survey remains at 24 hours and a lot of that seems to stem from tradition. Could you imagine what EMS would be like if we kept our protocols the same just out of tradition (and, to a degree, I’d speculate that some do). Accepting the status quo is not always in the best interests of ourselves and certainly not in the best interests of our patients. However, many of us do and a lot of that is because of the “it’s just always been that way” mentality.

I don’t know about you but I’m all for bucking tradition (whenever and however possible).

I wrote about EMS 2.0 in my last post and it’s very much inclusive of some of the issues that possibly lead to EMS apathy. One think CK and I discussed earlier was the need to have better pay for EMS crewmembers and treatment that actually makes a difference. I agree 100%. Part of the overhaul of EMS will be addressing the factors that make EMTs and medics want to jump ship. I know of several people who are working in EMS and in school for areas of study that have little, if anything, to do with EMS. A lot of people see EMS as a stepping stone or as a means to collect a check while they’re in school. If that’s what they want, that’s fine. I’m not going to fault them if it’s really what they want. However, I think we have too many people with that mentality and we need to do all we can to reduce those who will let their licenses lapse after they graduate from school. We need to increase the number of people who truly care about EMS, its future, about making it better and, just as important, who are in it for long-haul. We need people whose long term career plans are to stay in EMS for as long as they possibly can, be it on the front lines or in EMS education.

The pay thing is an important factor to address as well. The last salary survey that JEMS performed is very telling. Did you know that even within EMS itself there are big salary discrepancies? The average EMT makes just over $28,000 and the average medic makes about $38,000 (the medic making more is understandable since they have more education than a Basic). However, if you continue on to support staff, an IT manager makes about $68,000. Wow. Now, I’m not downplaying the training and long hours that IT people put in and they are very important to what we do. However, I don’t like the huge gap in pay between those on the front line and someone who essentially works behind the scenes. Those who are directly responsible for patient care should be paid better than they are. Remember, these numbers are averages and many don’t make as much as the survey claims is the median. Especially in settings like mine, a medic may not make even over $30,000 a year. The lower pay is a slap in the face of those who are on the front line and who work long hours and spend so much time away from their families, compared to others who make more and work 9-5 Monday-Friday.

Changes will happen but it will take time. It took nurses decades to get the respect and pay they have. However, they earned their respect and higher pay. Simply put, they insisted on more education and more accountability in their profession. They demanded that they be allowed to give better patient care overall and they proved that they deserve what they’ve achieved. I’m not saying that us in EMS haven’t earned respect but we, as a profession, haven’t done enough in the areas of education and accountability. EMS 2.0 is a great step in the right direction but implementing it is going to take some doing. We have to make it attractive to the decision makers in order to truly make this successful. We can push for it all we want but we have to get our higher-ups on board in order to make it happen. That’s where we take pages from nursing’s playbook and act accordingly.

What do you think can be done in order to combat apathy within EMS? What can we do to improve our working conditions, pay and our ability to care for our patients? How can we make EMS a legitimate career and profession rather than a stepping stone to something else? Please feel free to leave your thoughts as a comment or you can email them to me (you can leave your name off if you wish). I may use the ideas in another post in the future.

As I write this, I don’t have my Word Press dashboard open so I have no idea how long it’s been since I’ve written something. I know it’s been a good minute. For some reason anytime I sit and try to write I get some kind of weird writers block. I’ve had blogs before (and have a couple of others now) but it’s been happening no matter what I’ve been wanting to write about. It’s been the strangest thing. I sure hope it goes away.

At least let me get through this post.

My last shift was rather interesting. I hauled a psych patient to a facility that is better equipped to handle the case. The medic had our passenger calm during the whole ride, which was great considering that the PT had threatened to kill the E.R. doc before a transfer for a psych eval was arranged. It seems the pt also was suicidal and had made at least a few attempts. All in all, it was an uneventful transport and the pt even slept part of the way to the other hospital. Now, my EMS brethren might be thinking “so? I do this everyday.”

Was your last suicidal and homicidal patient a peds case?

My pt was under 10.

How in the world does this happen? There are a lot of conspiracy theories but who knows what’s really going on. I just couldn’t believe that a kid, so young, would be in that state. It made me somewhat sad but also made me wonder if some of those conspiracy theories might be true (one involves a relative having custody of him and turning him that way so she could get a check off of him). That thought made me mad. Regardless, I hope he’s getting help and that it’s not too late. Otherwise he might just be a good candidate to be one of these people who are locked in the padded room for the rest of their lives.

I was chatting with an old friend the other day and we were doing the usual catch up stuff. He asked what I’m doing these days and I told him that I’m an EMT and hoping to get into medic school this fall. “Oh, so you’re an ambulance driver.” I tried to explain to him that there was a difference but his opinion is that of so many people around us. You know the opinion that all we are is a fancy taxicab with loud sirens and pretty red lights. It’s sad that people don’t see us as real medical practitioners but that’s going to take some time. That’s why I wholeheartedly support the project known as Chronicles of EMS. It’s a show that follows medics and EMTs while they’re doing their jobs. This is a reality show, not some piece of garbage like Trauma on NBC (more on that in a minute). It shows EMS for what it is and that doesn’t give in to the stereotypes that the fictional shows give (and thus is believed by Joe Public). If you haven’t checked it out yet, I highly encourage you to do so. It’s all part of the EMS 2.0 movement, one of the many steps in the process. This is the step that seeks to educate the public in what it is that EMS does and helps them to see that, yes, we are real medical practitioners. It will be nice when the day comes that we’re seen as a legitimate part of the medical community and not just a transport service.

Now some thoughts on NBC’s Trauma: Trauma is a fictional (yes, I know it’s meant to just be a show) that follows some fictional members of an EMS in San Francisco. It not only shows them “in action” (you’ll understand why I call it that in a moment) but it shows all the stuff in between (their personal lives). I have no problem with that; in fact I think that’s a good point of the show. That said, a lot of the stuff they show while the characters are on duty is just plain insane. Numerous times they show sex in the back of the truck or in the station and all types of unprofessional behavior (including letting some poor dispatcher have it for a problem that’s beyond her control). Some of the medical practice they show is dodgy at best and a lot of the things the characters do would get licenses revoked in a lot of cases. The worst part: At the end of one episode they had the audacity to show the following message just before the credits:

“Dedicated to the men and women of Emergency Medical Services.”

Honestly, I was somewhat offended by that. They just got finished showing an episode full of unprofessional and outright reckless conduct by the characters and yet they want to dedicate that garbage to us? I was floored. Again, I realize this is “just a show” but think about how police officers feel about shows like Law and Order and how doctors feel about Grey’s Anatomy. These shows make them look just as unprofessional and I know of a lot of people who don’t like those shows for those reasons. That’s how I feel about Trauma… they make us look like loose cannons and then have the nerve to say the show is dedicated to us. It’s unreal and it’s degrading.

I mentioned EMS 2.0 a few minutes ago and lots of people wonder about it. Pretty much, it’s a grassroots movement by EMS people themselves to improve our neck of medical practice from the ground up. That’s everything from dispatch to protocols to QA. It also calls for education and licensing (yes, licensing, not certification) standards to be increased at all levels of EMS. It also includes demanding better working conditions and much deserved respect. Better patient outcomes, more options for the EMT or medic as far as treatment goes and, ultimately, the recognition of EMS as a real profession and not a trade. As the name suggests, EMS 2.0 is a complete overhaul (or reboot if you want to keep with the computer metaphor) of EMS as a whole. The system isn’t dead but it could stand to be improved. What needs to be done is keeping and improving that which works, throwing out what doesn’t work and giving us even more tools. One of the things I’d love to see is the ability for a paramedic to use his clinical knowledge (gasp!) and make a determination on whether or not the patient really needs to be transported to the hospital, if the patient can be treated right where they are or if alternate transport to the patient’s primary doctor or other appropriate medical service can be arranged.

I’m all for anything that can make EMS better and where I can be of more use. I’m hoping to start paramedic school this fall because I want to be the most use to my patients that I possibly can be. I also plan to continue my education further after paramedic but I haven’t decided exactly what I want to do just yet. The betterment of EMS is something that everyone, including those in EMS and the general public, should strive for.

It has come to our attention from several emergency rooms that many EMS narratives have taken a decidedly creative direction lately. Effective immediately, all members are to refrain from using slang and abbreviations to describe patients, such as the following.

Cardiac patients should not be referred to as suffering from MUH (messed up heart), PBS (pretty bad shape), PCL (pre-code looking) or HIBGIA (had it before, got it again).

Stroke patients are NOT “Charlie Carrots”. Nor are rescuers to use CCFCCP (Coo Coo for Cocoa Puffs) to describe their mental state.

Trauma patients are not CATS (cut all to sh*t), FDGB (fall down, go boom), TBC (total body crunch) or “hamburger helper”. Similarly, descriptions of a car crash do not have to include phrases like “negative vehicle to vehicle interface” or “terminal deceleration syndrome”.

HAZMAT teams are highly trained professionals, not “glow worms”.

Persons with altered mental states as a result of drug use are not considered “pharmaceutically gifted”.

Gunshot wounds to the head are not “trans-occipital implants”.

The homeless are not “urban outdoorsmen,” nor is endotracheal intubation referred to as a “PVC Challenge”.

And finally, do not refer to recently deceased persons as being “paws up,” ART (assuming room temperature), CC (Cancel Christmas), CTD (circling the drain), DRT (dead right there) or NLPR (no long playing records).

I know you will all join me in respecting the cultural diversity of our patients to include their medical orientations in creating proper narratives and log entries.

Anyway… in my eight months as an EMT I have, of course, seen loads of stuff that has pissed me off, made me shake my head and things that have made me question why God would allow humanity to continue. Tonight I had one of those moments where in my mind realizes what I’m seeing is something that no human being should ever have to see.

As we say in EMS, I had a crispy critter.

I had my volley radio on and heard dispatch page out a neighboring department for MVC with entrapment and also advised that the car was on fire. I started putting on my shoes because I just knew my department would also be paged. Sure enough, the tones drop and I’m out the door. The rescue truck was already pulling out of the station when I got there so I followed in my POV. Before we even arrived, we heard units from the primary FD go on scene. About a minute later they called for the ME.

We get there, gear up and help out with putting the rest of the fire out. After the coroner arrives and does his thing, I helped get the body out of the car. We load her up and send her on her way.

Seems pretty simple, huh?

The entire time I’m there, I’m just looking and observing. This was my first burn victim and I couldn’t absorb all that had happened fast enough. I’ve always been told that the smell of a burned body is something that you’ll never forget. That tidbit is absolutely correct. The sights are also something I’ll never forget. By the position of the body, I could tell that she had obviously been in a great deal of pain but that she was also struggling to get out of the car by any means possible. Her shoes (obviously with her feet still in them) had melted to the floor. Most of her skin had been burned away too. Muscles, tendons, organs, the whole works was in plain view. I couldn’t help but think, “wow, this would actually be a good lesson in A&P.” I also couldn’t help but feel bad for her family. She’s a member of a family somewhere and they’re missing a loved one tonight. There wasn’t anything we could have done to save her but it still sucks hardcore.

It also really sucks that this had to happen on Easter.

I’ll certainly never forget tonight. The sights, the smells, the whole experience will always stick with me. Here I am writing at around 0200 while my wife is asleep next to me. I just had to get it all out I suppose. For the therapists out there who want to know how I feel… well, I haven’t quite decided. Of course, I’m sad that there was nothing that could be done to save her life but I also know that it just wasn’t meant for that to happen tonight. I feel sadness for her and her family. No one should ever have to get the news that their loved one burned up in a car and no one should ever have to die such a horrific death. I certainly hope that I never see anything like this again but I know that there’s a good chance that I will see it again, probably more than once.

It’s a good reminder to always take the time to tell your loved ones that you do love them. You never know when you’ll be answering your last call or otherwise leaving this world.

As a preview, I wanted to go ahead and post on here that the NBC garbage show known as Trauma is apparently back on the air. I don’t have the time to post my extended thoughts on this show right now but I will do my best to get a post up tonight that goes into more detail. A good summary would be to say that the show is junk and portrays EMS as irresponsible and does nothing to increase the fact that we we are legitimate medical practitioners. In fact it makes EMS look very unprofessional and reckless.

You can go here to view the show for yourself. Don’t be surprised if you can’t make it past the first five minutes though.

This post will probably be a bit random however I hope there will emerge a theme. Thanks to something I just saw on Twitter I have the phrase “you can’t fix stupid” stuck in my head.

The last few days have been full of stupid.

There was a pretty good battle going on Twitter earlier between the Twitter EMS community-at-large versus one blogger. His blog, “Rethink EMS,” is a somewhat interesting read. Pretty much, the interest only extends to being shown an example of “those who don’t know what they’re talking about shouldn’t be telling me how to do my job.” To sum it up, he’s just some guy who doesn’t work in EMS, never has worked in EMS and does not want to work in EMS. Yet, he knows everything about EMS including what treatments work and don’t work. He contends in his post that he would do away with ALS if it were up to him and even goes on to call for an end to intubation outside of the hospital. Oh, he even says that pain management in the field is unnecessary.

Really?

While I’m sure he means well and I’m sure he’s done his research, he fails to see the big picture. Does he really expect us to withhold pain management from a patient (assuming the service is ALS and a medic is on board)? At my place our transport times are routinely 20 minutes or more. You’re telling me that my medic partner shouldn’t be allowed to deliver pain meds, even if this patient has a compound fracture? Would he want his mother treated in this way? How about himself?

That’s just one example. I won’t even mention intubation which is obviously effective where the airway and oxygenation are so compromised that such a drastic measure would be necessary. Contrary to what he contends, these measures typically would not delay hospital care. Is ALS always needed? Of course not. In fact, I’d say most of the calls I encounter are truly a BLS call but there have also been plenty of times where ALS intervention was needed and did not cause the patient any harm nor did it delay definitive care.

The truth is, this guy is likely just misguided in his views. At least that’s what I hope. He cites many studies and much research but really what does it prove? The studies he cites have not been policy changers in EMS, nor should they be. Neither do I think that someone who has little, if any, EMS training, let alone medical training of any kind, should be telling us how to do our jobs and what protocols to keep and which ones to ditch. This kid thinks that someone should only get ALS care if they’re circling the drain. I’m sorry but I disagree. The patient should start receiving care immediately whenever possible (and it usually is). This includes pain management and advanced airway management if indicated. For him to sit in his chair and tell us that what we do is wrong, well, it kind of chaps my rear. I hope he gets educated about what it is we do and why we do it.